Infective endocarditis associated with atopic dermatitis

Abstract

A 34-year-old man with a history of severe atopic dermatitis from infancy was admitted to the local hospital with the complaints of high fever, general fatigue, and muscle pain. There was a Janeway lesion on the soles of his feet. An echocardiogram showed large vegetation on the postero-medial commisure of the mitral valve. The blood culture test demonstrated Staphylococcus aureus, and the patient was diagnosed as having infective endocarditis. The patient was effectively treated with cefazoline (6.0 g/day) and vancomycin(1.0-2.0 g/day) for 38 days, and the extent of vegetation was shown by echocardiography to be smaller than it was before treatment. Colonization of Staphylococcus aureus is commonly observed in skin lesions of atopic dermatitis, and its incidence is significantly higher in patients with atopic dermatitis than in healthy individuals. Actually, Staphylococcus aureus was found in several skin lesions of the present patient. As is found also in the history of liver abscess, the presence of atopic dermatitis may be closely related to the occurrence of infective endocarditis in this patient. We would suggest that careful observation is necessary when atopic dermatitis is accompanied by the presence of Staphylococcus aureus, even though the patient has no history of organic heart disease.